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Big Hands

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A man in his 20s presents to the ED for an ankle injury.  He recently moved to the united states and has never seen a doctor before.  He admits to years of gradually worsening joint pain.  He states his hands have always looked “fatter” than everyone else he knows

Vital Signs & Physical Exam:

Vital signs are normal.   Physical exam is otherwise normal except for ankle tenderness and thick, hairy hands (my hand is the one on the left)

 

Initial Diagnostic Testing:

  • Imaging: ankle x-ray shows no fracture

WHAT IS THE MOST LIKELY DIAGNOSIS?

  1. hypothyroidism
  2. a pituitary condition
  3. a parathyroid condition
  4. vitamin D deficiency

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ANSWER: 

  • a pituitary condition, acromegally

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

 

CLICK HERE TO LEAR MORE ABOUT THIS BOOK CASE LESSONS:

CASE LESSONS: OTHER CHOICES

  1. hypothyroidism: myxedema coma can cause thickened skin
  2. a parathyroid condition:
  3. vitamin D deficiency: tends to cause
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